Provider Demographics
NPI:1841349305
Name:TRI-STATE ANESTHESIA ASSOCIATES INC
Entity type:Organization
Organization Name:TRI-STATE ANESTHESIA ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:LANHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:513-779-1270
Mailing Address - Street 1:8229 SWEET BRIAR CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044
Mailing Address - Country:US
Mailing Address - Phone:513-779-1270
Mailing Address - Fax:
Practice Address - Street 1:8229 SWEET BRIAR CT
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044
Practice Address - Country:US
Practice Address - Phone:513-779-1270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0755580Medicaid
OH0755580Medicaid